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Learn how aging at home is possible with proper planning for your everyday needs and living space.

“For me, aging at home is really making wherever you are living as safe as possible so that it could meet your needs for today and tomorrow.”
Audrey Miller, Managing Director of Elder Caring Inc.

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Transcript

Intro speaker:

Hello, and welcome to Matters Beyond Wealth with your host, Leanne Kaufman, president and CEO of RBC Royal Trust. For most of us, talking about subjects like aging, late life and estate planning, isn't easy. That's why we're going to help get the conversation started on this podcast, while benefiting from the insights and expertise of some of the country's top experts. We want to bring you information today that will help to protect you and your family in the future. Now here's your host, Leanne.

Leanne Kaufman:

Hello, I'm Leanne Kaufman and welcome to RBC Wealth Management Canada's Matters Beyond Wealth. I'm delighted to introduce our guest today, Audrey Miller. Audrey is a registered Social Worker and Canadian Life Care Planner with over 30 years of experience counseling individuals and families on health and rehabilitation. She's the Founder and Managing Director of Elder Caring Inc. A consulting firm that provides direct care-management services to seniors, their caregivers and families.

In addition to her consultation services, Audrey is a trusted advisor, educating professionals in the legal and financial communities about aging issues, and the needs of caregivers. She's the author of hundreds of articles and blogs, and shares her expertise on her website eldercaring.ca. She also has several videos available on the eCaring channel.

We at RBC have also partnered with Audrey and her firm, to help raise awareness of these issues. And I am delighted to welcome Audrey to our podcast.

Audrey, thanks for joining us today to talk about aging at home, safely and securely, and why this matters beyond wealth.

Audrey Miller:

My pleasure, Leanne. Thank you.

Leanne Kaufman:

It's no longer really news that Canadians are living longer than ever before, but what maybe has become news of late, and most particularly since the impact of the pandemic was felt so disproportionately in our long term care homes, and other congregant living settings, is that the majority of us would prefer to live in our own homes for as long as possible. This is going to become an even greater issue as the number of aging Canadians continues to grow. We know from the 2021 census data, for example, that in the next 25 years, the number of people that are over the age of 85 is expected to triple, to nearly 2.5 million Canadians. But we know that these are parts of our future that few of us take the time to consider, and certainly, rarely, plan for. Audrey, let's just start at the beginning here, and that phrase “aging at home”—or sometimes you hear “aging in place”—has become really common in the last couple of years. What exactly are people talking about when they use these phrases?

Audrey Miller:

Thanks, Leanne. I think for me, it means accommodating your home to meet your needs both today, and tomorrow, making it into a safe haven where you can age safely. And that includes a number of things. It includes the physical challenges that may be posed of what your home looks like. Are there stairs that are of concern? Is the bathroom only on the second story? And then how do you access that easily without putting in a stair glide, or an elevator? Some of the older homes have poor lighting. It's ensuring that there's good lighting in place, but it also, for me, means understanding what your social needs are, being able to connect with friends, and your community and your neighbors. We don't want home to be an isolating place. It's looking outside of where can you access resources if you need them, hospitals, doctors, even groceries and supplies, getting your hair done, or being able to go out and enjoy a cup of coffee with someone. Socialization is a large part of that, and the home can also be a lonely place.

I think, as we look at aging in place, we have to consider all of those things. And including, perhaps, assistance with some of our activities of daily living and our instrumental activities of daily living, which are things like the shopping, and the cooking, and the cleaning, the laundry. If you are having trouble with those things, well then, can you bring someone in to help you? How will you meet those challenges? So I think for me, aging at home, aging in place, is really making wherever it is you're living as safe as possible so that it could meet your needs for today, and tomorrow.

Leanne Kaufman:

Clearly financial security and proper planning is a big component of making sure that we can age at home the way that we want to. But what do you see as some of the biggest impediments to staying at home as long as possible?

Audrey Miller:

I think there are a few. It's not a complete panacea to say “I'm going to stay at home.” There are a number of things that one needs to do to make sure that their home can suit their future needs. And we don't always know what health issues are around the corner for us. We're trying to be as prepared as possible.

The first thing that we often look at is safety. That's number one for me. And so, I look at the physical safety of the home. Are there handrails to go up the front stairs? Is there an easy access to a back door in case of emergency or safety? Is it possible to be on one level or if stairs are an issue, can they be accommodated? Is a stair glide, or an elevator an option?

But in addition to that, there's also social needs. And it's making sure that you're in a community that works for you. You've got people around you. You've got neighbors around you. You have access to resources that can come into your home. A little more difficult if you're in a rural community, and we certainly saw that during the pandemic, that resources were not available to come into our home. We had to be very creative in ensuring that there was a social component, as well as a cognitive stimulation component. As you know, loneliness is a major health detriment for seniors, and in fact, for all of us. The home can also be a very lonely place and ensuring that supports are available is another piece of that. I mentioned community, as well, and it's access to transportation, and it's access to hospitals, and it's really access to an environment that can't necessarily be duplicated in your own home. But it's ensuring that the socialization, the resources, and the supports are there.

For some, it might be the issue of bringing in another set of hands, for example. We look at our instrumental activities of daily living such as the shopping, the cooking, the laundry, the cleaning, which we may need help with; certainly shoveling the snow. And that's in addition to the activities of daily living, where we might need help as well, which are the concrete things such as bathing, toileting, feeding, grooming. There's a variety of things to look at, but really important that as we look down that road we have a plan to understand what kind of services that we need to access, and to be able to think about how best to do that.

Leanne Kaufman:

You mentioned a lot of key areas that need to be considered. Let's just break down a couple of those and go a little deeper. First of all, the physical space. You mentioned things like the shower grab bars, and the stair chair lifts, and these are things that might more commonly be thought about when we consider how we might need to modify to age at home. What other kinds of considerations do you suggest people think about when we're talking about the physical space?

Audrey Miller:

Right. So accessibility, can I change that bathtub into a walk-in shower? Is there a bath seat in addition to grab bars? Is there a handheld shower hose? For example. Do I have a safety mat in the shower? Have I removed all the little scatter rugs that are not securely connected to the floor? Is there good lighting? Is the pathway from the bedroom to the bathroom free of clutter? Are there tripping hazards, phone cords, television cords, electrical cords? It's really kind of safety proofing the home, which I recommend we do at any stage because, perhaps you can trip over your dog. But just being aware of what's around us, and trying to remove the things that are most obvious so we can prevent a fall, which is something we all want to do.

I think there's also personal emergency response systems that are physical, in that you wear it. You can wear it as a pendant, or you can wear it as a bracelet and it's able to detect a fall should one occur. It's not able to prevent a fall, but if there is a problem, one is able to access help by the press of a button. And some of the devices today, the button doesn't even have to be pressed. It can actually detect if there is a change in height. If someone has fallen, not able to press a button, then it will detect that change and will call out to you, ask if you are okay, and give you an opportunity to respond, before sending a first responder to attend to you, for example.

Leanne Kaufman:

I think I want to come back to technology in just a minute, because I think it's really creating some of the capacity for Canadians, and giving peace of mind to the family, to make this an option for more people than it used to be. But before we move on to the technology side of things, you had also mentioned earlier the caregiving and the support at home for activities of everyday living, as well as the more personal care side of things. Can you give our listeners a bit of an overview regarding the kinds of public versus private help available, and maybe, just some very broad sense of what the costs of both of those could be?

Audrey Miller:

Sure. You know, we're very lucky that we have universal healthcare here, and healthcare is not means tested. The healthcare is through the provincial health authority, whichever province you are in, and it's based on need; what need do you have? And unfortunately, there's some shortages out there. And so, care now is available to the most needy, on a publicly funded basis—so no charge to you. But what might be available is the services of a personal support worker, or a PSW, who is able to supervise bathing, for example, or assist with morning routine, or assist with evening routine. Hours are limited, unfortunately, and it's never enough, but it's certainly a resource that I encourage every family to explore as the first stop for accessing that kind of care. What many families do is they'll accept whatever is available from the provincial government, and then opt to supplement it privately.

And I always recommend if one is choosing the private route that they choose a caregiver that is connected to a reputable home healthcare company. Personal support workers are not regulated, and so anyone can call themselves a PSW. Working with a reputable home healthcare agency, they have checked the references, checked the educational background, checked the training and experience that the person says they have, and provide their own training, and also provide a police records check for vulnerable persons. The individual will be bonded. They provide supervision. They ensure that first aid is up to date, as well as specialized training. If your loved one has dementia, for example, you want a caregiver who is familiar and comfortable working with someone with dementia.

Today on average, across Canada, we're looking at about $35 upwards per hour and agencies often have a minimum of three or four hours. And there's a minimum because, oftentimes, the personal support worker has to travel across the city. They want to make sure it's worth that individual's time. The one feature I really like about using an agency, and the agencies I choose, on behalf of my clients, or make recommendations about, is that the level of supervision is there. Oftentimes, there's a nurse supervisor. And if that caregiver is sick, the agency can send a replacement, which I think is so important. You as a family caregiver, don't need to worry that oh my goodness, the caregiver, isn't going to show up because they're sick, or they're going to show up while sick, and get your mom or dad sick. I think those are some of the features.

Certainly, you can find a caregiver on your own. It might be through your own word of mouth, through church, or synagogue, or community center, or neighbor, someone who you feel good about and has the experience that you require. Of course, personality is a big piece of this. Do you want someone who's talkative? Do you want someone who's quiet? Is there a linguistic issue that we need to make sure that we can attend to? As well as cultural. Meaning are there certain meals, or preferences, that the person would prefer? You're in charge when you bring someone into your home, it absolutely can feel like an invasion of privacy, but they're there to help ensure that you can remain safely at home. It's a bit of a give and take there, if you will.

Leanne Kaufman:

It is such a personal relationship, isn't it? You really are inviting someone into your home to help with some of your biggest vulnerabilities. The fit is so important. I'm not sure that we always think about that.

Audrey Miller:

Absolutely.

Leanne Kaufman:

Let's go back to this topic of the technology for a minute, and how technology can support individuals to stay longer in their homes. And also, the family members can really get peace of mind, in some instances, from some of this new technology that's coming out. You mentioned the advances in the fall detection systems. Can you share some other examples of technologies and how they're working in practical terms?

Audrey Miller:

Technology's been fantastic, but I will also say it doesn't replace human contact. We have systems where there could be reminders for medication alerts. I don't need to name any of the companies that use them. But you know, Google: What time is it, what day is it, what's my agenda for today? As well as, being able to provide queuing and alerts for medication uptake. So those have come a long way: Turn on my lights, turn off my lights. Is everything closed? Is the alarm system on? I'm going to sleep now.

The other thing that families have used is Skype, or access to a camera, so that they can see what their loved one might be doing. For those with cognitive issues that becomes a really big deal, and trying to respect someone's independence. And for me, it's independence versus safety.

Alerts on the door, for example, one can hear from outside the home if it's set up in such a way that, aha, the doorbell is rung. Now, let me see if mom is actually going to respond to that doorbell. If she's going to open the door—which is a big concern, right? Who's coming to the door, and is your mom or dad able to know if it's a friendly face, or not a friendly face, at the door? Cameras are being used more and more. We're also starting to see some health devices that are being used within the home. And for me, these are early days, but there are some devices that are able to you know you stand on a mat while you brush your teeth and it can actually take your blood pressure, or it can measure your heart. As I say, these are early days for those kinds of things, and they're not commonplace, but they're starting to be available. The medication can be monitored via computer, for example, through telehealth system, to be able to access a professional on the other end of the camera to review one's health, for example.

Leanne Kaufman:

They're all getting very fancy and I do see great benefit to some of the things we're talking about today, helping people to stay in their home longer than they might have otherwise been able to in years past. Just to wrap us up here, Audrey, you have worked with so many families and healthcare providers over the years, and I'm sure you must have many, many stories you can share with us. I'm sure this won't be the last time that we chat here. But for now, if you hope listeners really only remember one thing about aging at home safely and securely, what would that one thing be?

Audrey Miller:

I think it's the ability to think outside the box and to think about the “what if's.” What I didn't mention today are some of the home sharing opportunities, and I think maybe that's a conversation for our next chat. But there's a new way of being able to share your home, so you may not have to live alone. And so, as I say, thinking outside the box and really exploring your options, so you know what costs are, you know what might work for you, is really part of the planning process. And I encourage families to start that as soon as they can.

Leanne Kaufman:

Kind of showing that the Golden Girls were ahead of their time, as an example of sharing our homes.

Audrey Miller:

Exactly.

Leanne Kaufman:

Thanks so much, Audrey, for joining us today and sharing your insights regarding why aging at home matters beyond wealth.

Audrey Miller:

My pleasure, Leanne. Thank you.

Leanne Kaufman:

You can find more about Audrey, and her work with Elder Caring Inc. at eldercaring.ca or you can find her on Twitter @eldercareexpert, and LinkedIn at Audrey Miller. Until next time, I'm Leanne Kaufman. Thank you for joining us.

Outro speaker:

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